Healthcare Provider Details

I. General information

NPI: 1720206030
Provider Name (Legal Business Name): ANN WOYTAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10877 CONDUCTOR BLVD STE 300
SUTTER CREEK CA
95685-9688
US

IV. Provider business mailing address

PO BOX 1953
SUTTER CREEK CA
95685
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-6412
  • Fax:
Mailing address:
  • Phone: 209-267-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: